Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury

Yolsuriyanwong, Kamthorn; Marcotte, Eric; Venu, Mukund; Chand, Bipan

doi:10.1007/s00464-018-6562-9

Cited by 12 publications

(6 citation statements)

References 33 publications

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“…The terminal branches of the vagus nerve have the peristaltic effect of coordinating the pylorus and duodenum, and can maintain appropriate pyloric tension, prevent gastric emptying disorders, reduce gastric acid secretion, and control gastric acid reflux to a certain extent (12,13). It was confirmed in a previously published study that preservation of the abdominal branches of the vagus nerve significantly improves postoperative gastrointestinal motility and reduces the incidence of gastroparesis in patients with HH (14) (15). López-Soldado et al found that the impact of liver glycogen regulation on food intake and glucose homeostasis was dependent on the hepatic branch of the vagus nerve; therefore, the hepatic branch of the vagus nerve has certain advantages in postoperative blood glucose and lipid control in patients with diabetes (16).…”

Section: Discussionmentioning

confidence: 81%

Laparoscopic total left-sided surgical approach versus traditional bilateral surgical approach for treating hiatal hernia: a study protocol for a randomized controlled trial

Zheng¹,

Zhang²,

Xin³

et al. 2021

Ann Transl Med

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Background: In China, guidelines for the treatment of hiatal hernia (HH) are lacking. Furthermore, efficacy and safety assessments of surgical approaches for HH and for the protection of the vagus nerve and organ function are needed. Therefore, the present clinical trial is being conducted to establish the normative treatment for HH. Methods:The current trial is an ongoing, single-center, randomized controlled trial of patients with HH. The total sample size required for the trial (July 2020-December 2023) is approximately 114 patients.Patients will be randomly assigned to either an experimental group (total left-sided surgical approach; TLSA) or a control group (traditional bilateral surgical approach; TBSA) at a ratio of 1:1 using the block randomization method. We will use case report forms (CRFs) and electronic data capture (EDC) systems to obtain demographic information, preoperative laboratory tests, auxiliary examination results, operation information, and postoperative condition. The patients will be followed up for 3 years after surgery. The primary endpoint is the gastrointestinal quality-of-life index (GIQLI) at 1 year. The secondary endpoints include an efficacy evaluation index [consisting of the incidence of gallstones and gastric emptying disorders, gastrointestinal function recovery time, visual analog scale (VAS) scores, objective evaluation of postoperative indices, and surgical information] and a safety evaluation index (consisting of the incidence of postoperative complications, the 30-day postoperative mortality rate, and the HH recurrence rate at 1 and 3 years after surgery).Discussion: TLSA can protect the normal physiological function of organs to a certain extent by protecting the vagus nerve from injury, and has satisfactory short-and long-term efficacy. There is no significant difference in the incidence of postoperative complications and surgical safety between TLSA and TBSA. Our findings will facilitate clinical decision-making for HH and improve the life quality of patients.

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Section: Discussionmentioning

confidence: 81%

Laparoscopic total left-sided surgical approach versus traditional bilateral surgical approach for treating hiatal hernia: a study protocol for a randomized controlled trial

Zheng¹,

Zhang²,

Xin³

et al. 2021

Ann Transl Med

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“…With the accumulation of food in the stomach, the risk of gastroptosis and enfoldment in the duodenal bulb markedly increased, which might lead to gastric outlet obstruction. The vagal nerve injury arising from thoracic and upper abdominal operations, including hiatal hernia repair, may result in delayed gastric emptying and gastroparesis [ 16 ]. During operation, we saw omentum attached tightly to the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report

Xie

Zhu

et al. 2022

BMC Gastroenterol

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Background Giant hiatal hernia is defined as those with more than 30% of the stomach herniating into the chest cavity. The transabdominal laparoscopic approach is the well-established repair form for giant hiatal hernia. To our best knowledge, reports on post-operative gastric outlet obstruction of giant hiatal hernia repair have been scanty up till now. Case presentation A 45-year-old female patient was referred to the Emergency Department of our hospital with a chief complaint of acute right epigastric pain for 2 days. Physical examination revealed mild tenderness in the right epigastrium, without rebound tenderness or guarding. The abdominal computed tomography scan revealed a large low-density gastric artifact in the lower mediastinum—giant hiatal hernia. The barium swallow esophagogram and gastroscopy also confirmed the presence of a giant hiatal hernia. A transabdominal laparoscopic operation for reduction of the hernia contents and repair of the hiatal defect was performed. Her right epigastric pain alleviated obviously on the first postoperative day. On post-operative day five, however, she was presented with nausea and vomiting independent of meals. The nasogastric tube was inserted and kept in the stomach for 7 days. After removing the nasogastric tube, severe nausea and vomiting of the patient occurred again. Barium swallow revealed gastroptosis and enfoldment in the duodenal bulb, which indicated the presence of gastric outlet obstruction. Gastrojejunostomy was performed for her to relieve the gastric outlet obstruction. The patient was discharged on the tenth day after the second operation without any discomfort. During the regular follow-up period, she felt well and was satisfied with her status. Conclusions Facing the giant hiatal hernia repair, the reduction of the hernia contents and repair of the hiatal defect being well operated on are insufficient, and we must watch out the anatomical variation, like the deviation of partial intra-abdominal organs from their normal positions, as well as paying attention to the protection of abdominal vagal nerve during the operation. Post-operative gastric outlet obstruction of giant hiatal hernia repair is rare, while gastrojejunostomy can successfully relieve the gastric outlet obstruction.

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“…Particularly after lung transplantation, PSG may become manifest and due to gastroesophageal reflux, microaspirations to the lung and consequently bronchiolitis may occur [28]. The "vagal nerve integrity test" can be used to determine whether gastroparesis is secondary to VN injury or dysfunction [29]. We found that PSG-like upper gastrointestinal system symptoms occurred in the postoperative first week and regressed in the fourth week.…”

Section: Discussionmentioning

confidence: 99%

Transient postsurgical gastroparesis is accompanied by reversible changes of the cervical vagus nerve’s morphology after neck dissection – an ultrasound study

Özçağlayan

Ersözlü

2020

Med Ultrason

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Aims: During neck dissection (ND), the vagus nerve (VN) may be exposed to manipulation together with common carotid artery and internal jugular vein. The postsurgical gastroparesis was previous related to the VN injury. The aim of our study was to evaluate by ultrasound the VN changes in patients with unilateral and bilateral ND and to establish if there is a relationship between postoperative findings of VN and postsurgical gastroparesis.Material and methods: Seventeen patients in which 30 ND (4 unilateral and 13 bilateral) were performed, were enrolled in the study. The VN’s area and diameter were measured preoperative (baseline), one week (T1) and one month (T2) postoperative. Gastrointestinal symptoms were evaluated at T1 and T2 phases using the patient assessment of the upper gastrointestinal symptom severity index (PAGI-SYM).Results: There was a statistical difference between area and diameters of VN between T1 and baseline (p<0.001), and T1 and T2 phases (p<0.001), respectively. No statistical differences were detected at baseline and T2 phases in areas (p=0.934) and diameters (p>0.999). Gastrointestinal symptoms, found at the T1 phase regressed at T2 phase, were correlated with VN area and diameter changes (p<0.001).Conclusions: VN ultrasound clearly showed the transient dimensional changes of VN caused by manipulation in ND, which may lead to temporary gastrointestinal symptoms due to reversible dysfunction of VN.

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Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury

Cited by 12 publications

References 33 publications

Laparoscopic total left-sided surgical approach versus traditional bilateral surgical approach for treating hiatal hernia: a study protocol for a randomized controlled trial

Laparoscopic total left-sided surgical approach versus traditional bilateral surgical approach for treating hiatal hernia: a study protocol for a randomized controlled trial

Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report

Transient postsurgical gastroparesis is accompanied by reversible changes of the cervical vagus nerve’s morphology after neck dissection – an ultrasound study

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